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Are brand-name hospitals better?
December 09, 2011
Most hospitals don't operate independently but instead are part of a large health-care system that often has a well-known name. Think Baylor Health Care, the Cleveland Clinic, the Henry Ford Health system, and the Mayo Clinic.
We recently took a close look at 61 systems with at least five hospitals that publicly report data on hospital-acquired infections. We focused on bloodstream infections in their intensive-care units that stemmed from central-lines, which are large catheters used to deliver fluids, medication, and nutrition to patients. They are the most common hospital-acquired infections, and kill up to 25 percent of the people who develop them.
The data in our analysis came either from one of the 18 states that publicly report hospital-infection rates, or from The Leapfrog Group, a nonprofit organization in Washington, D.C., that focuses on improving health care in hospitals, in part by encouraging them to report information on infections and other measures. Many voluntarily agree to do so, but some still don't. For each system, we used the most recent data that was publicly available.
We think a hospital's ability to prevent those infections is a reflection of its overall commitment to preventing infections and improving patient safety. That's because there are proven, simple steps hospitals can take to prevent them.
Here's what we found:
1. A well-known name doesn't guarantee low infection rates.
The Cleveland Clinic, part of a system of 11 hospitals in Ohio and Florida, is one of the most famous hospitals in the country. U.S. News & World Report consistently ranks its cardiology department No. 1 and many of its other departments in the top 10. Yet our analysis found that both the flagship hospital in downtown Cleveland and the system as a whole scored substantially worse than the national average for bloodstream infections in its ICUs.
We were able to analyze data from eight of the Cleveland Clinic's hospitals for 2009, the year with the most recent publicly available data. (The others either didn't report data or reported them in a way we couldn't use for our analysis.) Overall, they reported 143 infections in 48,184 days that their patients spent with central lines in place, a rate 41 percent worse than the national average. And at the flagship hospital, the infection rate in its medical-cardiac ICU was just average, while the overall rate in all of its ICUs was almost twice the national average.
Some hospitals in similar environments—notably Henry Ford Hospital in Detroit—did substantially better. Ford reported just 14 infections in 28,062 central-line days, a rate 78 percent better than average. And the Henry Ford Health system, with data from five of its six hospitals in Michigan, had an infection rate 73 percent lower than the national average, one of the best among any of the hospital systems we studied.
The Cleveland Clinic told us that in recent years it has taken several steps to improve bloodstream-infection rates, including frequent reviews of reported infections, participation in regional and national collaboratives to reduce infections, and the adoption of best practices in all of its hospitals. They say those measures have translated into substantial reductions in bloodstream-infection rates, which should appear in future publicly available reports.
2. Even good systems can have flaws.
Thirteen of the ones we looked at were able to reduce their number of bloodstream infections below the national average for each of their hospitals that reported data. But in many other systems, results varied considerably. For example, Kaiser Foundation Hospitals had an overall infection rate that was 36 percent lower than average. But its South San Francisco Medical Center had a rate almost three times higher than the national average. The nation's largest hospital system—the Hospital Corporation of America, headquartered in Nashville, Tenn.—had an infection rate close to the national average. But one of its hospitals, Lake City Medical Center in Lake City, Fla., had a rate 4.5 times higher than the national average.
"While some hospital systems are trying to solve the problem, patients still need to look at individual hospitals, not just systems," says John Santa, M.D., director of the Consumer Reports Health Ratings Center. "And hospital systems need to make sure the good changes they make at one hospital spread to every institution in their system."
3. Perfect is possible.
None of the hospital systems we analyzed reported zero bloodstream infections in all of their hospitals' ICUs. But many of them did for at least one hospital. For example, two in the Henry Ford system—Henry Ford West Bloomfield Hospital and Henry Ford Macomb Hospital-Warren Campus, both in Michigan—reported none over a one-year period. And six Hospital Corporation of America facilities reported zero infections in more than 1,000 central-line days: Terre Haute Regional Hospital in Indiana; Garden Park Medical Center in Gulfport, Miss.; Research Medical Center in Kansas City, Mo.; Menorah Medical Center in Overland Park, Kan.; St. David's Georgetown Hospital in Texas; and St. Mark's Hospital in Salt Lake City.
Even some systems that did poorly overall had standouts. Two of the Cleveland Clinic's hospitals—Euclid Hospital in Ohio and Huron Hospital in Cleveland—reported zero infections, for example.
Overall, 23 of the hospital systems we looked at reported infection rates substantially better than the national average. "That's encouraging," says Lisa McGiffert, director of Consumer Union's Safe Patient Project. "It means that hospitals don't have to just live with high infection rates—and that patients don't have to put up with unsafe hospitals. Patients should look for hospital ratings that include safety and error rates. If hospitals don't report such information, patients should consider going elsewhere."
4. Average isn't good enough.
Thirty-four of the hospital systems reported infection rates similar to the national average, which is 1.9 bloodstream infections for every 1,000 days its ICU patients spend with central lines in place. Our analysis suggests that the overall rate of such infections is on the decline, which is encouraging. But since many hospitals have shown that these infections can be completely eliminated, average isn't good enough. "People shopping for a safe car wouldn't buy one with an average safety rating when there are better options available," Santa says. "There shouldn't be any reason for them to put up with average hospitals, either."
5. Some hospitals don't provide enough information.
Overall, we now have data on bloodstream infections from more than 1,500 hospitals, 26 percent of U.S. hospitals. Some of the hospitals not included in our analysis do report bloodstream-infection data to their state but not in a way we can use, or voluntarily report data to Leapfrog for other aspects of care, but not for bloodstream infections. And while the number of hospitals reporting data has gone up in recent years, the fact that we can't provide information on nearly three-quarters of the hospitals highlights the need for more comprehensive reporting. Health-care reform should help because it requires the federal government to report information on bloodstream infections by hospital starting next year. But even if that information does become universally available, other important measures of hospital safety—such as surgical-site infections and drug errors—should also be accurately and frequently reported.
Bottom line: A famous name doesn't guarantee low bloodstream-infection rates, and results can vary considerably, even among hospitals in the same system. Before being admitted to a hospital, use our hospital Ratings to see how the hospitals in your area compare. If you don't have a choice, the Ratings can at least alert you to the problems you might encounter. And see our advice for avoiding hospital infections and other tips for making your stay as safe as possible.